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Awake Prone Positioning and Risk of Intubation in COVID-19 Many COVID-19 patients develop severe bilateral viral pneumonia, which evolves into acute respiratory distress syndrome (ARD). High-flow nasal oxygen therapy (HFNO) has been shown to be effective in decreasing the need for endotracheal intubation with patients with acute hypoxaemic respiratory failure (ARF). However, in patients with COVID-19, the recommendation is of early intubation and invasive mechanical ve...
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Do We Need to Diagnose ARDS? Acute respiratory distress syndrome (ARDS) is the clinical expression of acute, non-haemodynamic lung oedema. It is typically diagnosed by hypoxaemia, and bilateral lung infiltrates in the absence of increased capillary hydrostatic pressure. ARDS represents nearly a quarter of the ICU patients who require mechanical ventilation. There is significant research and literature on ARDS, with over 13,000 articles published on this syndrome since ...
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Increasing Efficiency Without Affecting Patient Outcomes The economic and clinical fragilities of healthcare systems around the globe have never been more visible than during the COVID-19 pandemic. In particular, the importance of resource allocation has been at the forefront. Weighing safety against costs when dealing with critically ill patients has been a source of dilemma for many healthcare professionals. When we evaluate the use of imaging in the ICU, we see that...
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Editorial October 12, 2020 Excess Deaths and the Great Pandemic of 2020 Howard Bauchner, Phil B. Fontanarosa JAMA. Published online October 12, 2020. doi:10.1001/jama.2020.20016 Two new reports in JAMA provide updated estimates regarding the mortality associated with the coronavirus disease 2019 (COVID-19) pandemic in the US. In a research letter by Woolf and colleagues, the authors update their analysis of the number of “excess” deaths in the U...
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Lung Histopathology: COVID-19 Compared to SARS, H1N1 The coronavirus disease has spread throughout the world and has resulted in many challenges for healthcare systems. It is a new disease with a significant burden of respiratory failure. This has led to questions about the pathogenesis and pulmonary pathology of COVID-19.  Patients with severe COVID-19 have respiratory failure with hypoxaemia, and acute bilateral pulmonary infiltrates. This is consistent with ...
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ICU Management & Practice, Volume 20 - Issue 3, 2020 PCT-guided Antibiotic Stewardship in COVID-19 Patients Professor Michael Mansour is a physician-scientist with a research concentration in immune responses against invading pathogens. He attends on the Clinical Transplant Infectious Diseases and Immunocompromised Host Service at the Massachusetts General Hospital - Division of Infectious Diseases, where he cares for solid and stem cell transplant recipien...
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Intensive Renal Replacement Therapy and Mechanical Ventilation Duration Acute kidney injury (AKI) is a global health issue, accounting for approximately two million deaths per year as well as presenting a heavy economic burden on healthcare systems. Hospital-acquired AKI is associated with increased risk of death and prolonged length of hospital stay. There are no effective treatments beyond supportive care for patients with AK from sepsis or hypotension. Sever...
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Better Planning of COVID-19 Vaccine Trials The world is desperate for a reliable vaccine against COVID-19. However, the pressure for such rapid introduction could lead to deployment of a vaccine that may be weakly effective. In order to avoid this from happening, three issues must be considered when planning COVID-19 vaccine trials. These include proof of vaccine efficacy and worthwhile efficacy, whether these trials should prioritise single-vaccine or multivaccine ...
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Editorials Convalescent plasma is ineffective for covid-19 Elizabeth B Pathak BMJ 2020; 371:m4072 doi: https://doi.org/10.1136/bmj.m4072  Lessons from the Placid Trial Convalescent plasma generated great enthusiasm in the earliest days of the coronavirus disease 2019 (covid-19) pandemic because of a plausible mechanism of action,1 its 100 year history of use in the treatment of other infectious diseases,2 and rapid availability from voluntary dono...
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ICU Management & Practice, Volume 20 - Issue 3, 2020 Unmasking the Triumphs, Tragedies, and Opportunities of the COVID-19 Pandemic The COVID-19 pandemic has resulted in many changes to society and the practice of critical care medicine. Perhaps now is the time to address deficiencies in communication and decision-making that impact quality of care provided to older patients with serious illness. The COVID-19 pandemic has created a juxtaposition of triump...
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